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Article ; Online: Acute Respiratory Distress Syndrome in Pregnancy: Updates in Principles and Practice.

Watts, Abigail / Duarte, Alexander G

2022 Volume 66, Issue 1, Page(s) 208–222

Abstract: Acute respiratory failure occurs in 0.05% to 0.3% of pregnancies and is precipitated by pulmonary and nonpulmonary insults. Acute respiratory distress syndrome (ARDS) is the rapid onset of hypoxemic respiratory failure associated with bilateral pulmonary ...

Abstract	Acute respiratory failure occurs in 0.05% to 0.3% of pregnancies and is precipitated by pulmonary and nonpulmonary insults. Acute respiratory distress syndrome (ARDS) is the rapid onset of hypoxemic respiratory failure associated with bilateral pulmonary opacities on chest imaging attributed to noncardiogenic pulmonary edema. The pathophysiological features of ARDS include hypoxemia, diminished lung volumes, and decreased lung compliance. While there is a paucity of data concerning ARDS in the pregnant individual, management principles do not vary significantly between pregnant and nonpregnant patients. The following review will discuss the diagnosis and management of the pregnant patient with ARDS.
MeSH term(s)	Humans ; Pregnancy ; Female ; Respiratory Distress Syndrome/diagnosis ; Respiratory Distress Syndrome/therapy
Language	English
Publishing date	2022-10-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	391207-3
ISSN	1532-5520 ; 0009-9201
ISSN (online)	1532-5520
ISSN	0009-9201
DOI	10.1097/GRF.0000000000000763
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Article ; Online: Utilization of Pulmonary Rehabilitation Following Hospitalization for COVID-19.

Duong, Brittany / Zaidan, Mohammed / Puebla Neira, Daniel / Polychronopoulou, Efstathia / Sharma, Gulshan / Duarte, Alexander G

Journal of cardiopulmonary rehabilitation and prevention

2023 Volume 43, Issue 6, Page(s) E27–E29

MeSH term(s)	Humans ; COVID-19 ; Hospitalization ; Pulmonary Disease, Chronic Obstructive/rehabilitation
Language	English
Publishing date	2023-09-07
Publishing country	United States
Document type	Letter
ZDB-ID	2272063-7
ISSN	1932-751X ; 1932-7501
ISSN (online)	1932-751X
ISSN	1932-7501
DOI	10.1097/HCR.0000000000000816
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Article ; Online: Corticosteroids and Outcomes in Solid Organ Transplant Recipients Infected With Severe Acute Respiratory Syndrome Coronavirus 2.

Nada, Khaled M / Polychronopoulou, Efstathia / Sharma, Gulshan / Duarte, Alexander G

Mayo Clinic proceedings. Innovations, quality & outcomes

2023 Volume 7, Issue 2, Page(s) 99–108

Abstract: Objective: To examine outcomes in organ transplant and nontransplant patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during the initial 22 months of the pandemic.: Patients and methods: We used Optum electronic ... ...

Abstract	Objective: To examine outcomes in organ transplant and nontransplant patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during the initial 22 months of the pandemic. Patients and methods: We used Optum electronic health records to compare outcomes between an adult transplant group and a propensity-matched nontransplant group that tested positive for SARS-CoV-2 from February 1, 2020, to December 15, 2021. Baseline characteristics, hospitalization, intensive care unit admission, mechanical ventilation, renal replacement therapy, inpatient, and 90-day mortality were compared between the transplant and nontransplant groups and among specific transplant recipients. Cox proportional analysis was used to examine hospitalization and mortality by organ transplant, medical therapy, sex, and the period of the pandemic. Results: We identified 876,959 patients with SARS-CoV-2 infection, of whom 3548 were organ transplant recipients. The transplant recipients had a higher risk of hospitalization (30.6% vs 25%, respectively; Conclusion: Among patients with SARS-CoV-2 infection, the transplant recipients were at a higher risk of hospitalization and inpatient mortality; however, mortality was mainly driven by advanced age and comorbidities rather than by transplant status or immunosuppressive medications. Lung transplant recipients had the greatest inpatient and 90-day mortality.
Language	English
Publishing date	2023-02-03
Publishing country	Netherlands
Document type	Journal Article
ISSN	2542-4548
ISSN (online)	2542-4548
DOI	10.1016/j.mayocpiqo.2023.01.002
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Article ; Online: Non-CF bronchiectasis: Orphan disease no longer.

Imam, Jaafer Saadi / Duarte, Alexander G

Respiratory medicine

2020 Volume 166, Page(s) 105940

Abstract: Bronchiectasis is a complex, chronic respiratory condition, characterized by frequent cough and exertional dyspnea due to a range of conditions that include inherited mucociliary defects, inhalational airway injury, immunodeficiency states and prior ... ...

Abstract	Bronchiectasis is a complex, chronic respiratory condition, characterized by frequent cough and exertional dyspnea due to a range of conditions that include inherited mucociliary defects, inhalational airway injury, immunodeficiency states and prior respiratory infections. For years, bronchiectasis was classified as either being caused by cystic fibrosis or non-cystic fibrosis. Non-cystic fibrosis bronchiectasis, once considered an orphan disease, is more prevalent worldwide in part due to greater availability of chest computed tomographic imaging. Identification of the cause of non-cystic fibrosis bronchiectasis with the use of chest imaging, laboratory testing, and microbiologic assessment of airway secretions can lead to initiation of specific therapies aimed at slowing disease progression. Nonpharmacologic therapies such as airway clearance techniques and pulmonary rehabilitation improve patient symptoms. Inhaled corticosteroids should not be routinely prescribed unless concomitant asthma or COPD is present. Inhaled antibiotics prescribed to individuals with >3 exacerbations per year are well tolerated, reduce airway bacteria load and may reduce the frequency of exacerbations. Likewise, chronic macrolide therapy reduces the frequency of exacerbations. Medical therapies for cystic fibrosis bronchiectasis may not be effective in treatment of non-cystic fibrosis bronchiectasis.
MeSH term(s)	Administration, Inhalation ; Anti-Bacterial Agents/administration & dosage ; Bronchiectasis/diagnosis ; Bronchiectasis/etiology ; Bronchiectasis/therapy ; Cystic Fibrosis ; Disease Progression ; Humans ; Rare Diseases ; Respiratory System/microbiology ; Respiratory Therapy/methods ; Respiratory Tract Infections/drug therapy ; Tomography, X-Ray Computed
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2020-03-27
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1003348-8
ISSN	1532-3064 ; 0954-6111
ISSN (online)	1532-3064
ISSN	0954-6111
DOI	10.1016/j.rmed.2020.105940
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Article: Structured Evaluation and Management of Patients with COPD in an Accredited Program.

Singh, Mandeep / Hsu, En Shuo / Polychronopoulou, Efstathia / Sharma, Gulshan / Duarte, Alexander G

Chronic obstructive pulmonary diseases (Miami, Fla.)

2023 Volume 10, Issue 3, Page(s) 297–307

Abstract: Background: Chronic obstructive pulmonary disease (COPD) is an ambulatory care-sensitive condition.: Methods: We compared the impact of care received by patients with COPD at Joint Commission-accredited, disease-specific clinics and primary care ... ...

Abstract	Background: Chronic obstructive pulmonary disease (COPD) is an ambulatory care-sensitive condition. Methods: We compared the impact of care received by patients with COPD at Joint Commission-accredited, disease-specific clinics and primary care clinics at an academic health care systemfrom April 2014 to March 2018. Patients with COPD ≥ 40 years old with ≥ 2 outpatient visits 30 days apart were identified. Baseline demographics, disease-specific performance measures, and health care utilization were compared between groups. Propensity matching was conducted and time to the first emergency department (ED) visit and hospitalization was performed using Cox regression analysis. Results: Of 4646 unique patients with COPD, 1114 were treated at disease-specific clinics and 3532 at primary care clinics. The entire group was predominantly female (58.8 %), non-Hispanic White (74.2 %) with a mean age of 65.4 ± 11.4 years consisting of current (47.6 %) or former smokers (38.4 %). In the disease-specific group, performance measures were performed more frequently, and lower rates of ED visits (hazard ratio [HR]=0.31, 95% confidence interval [CI] 0.18-0.54) and hospitalizations (HR 0.41, 95% CI 0.21-0.79) noted in comparison to the primary care group. Conclusions: In this observational study, the implementation of achronic disease management program through accredited disease-specific clinics for patients with COPD was associated with reduced all-cause ED visits and hospitalizations.
Language	English
Publishing date	2023-07-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	2771715-X
ISSN	2372-952X
ISSN	2372-952X
DOI	10.15326/jcopdf.2022.0366
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Article: Liver transplant recipient with respiratory failure due to pulmonary fibrosis related to telomere disease requiring lung transplantation.

Singh, Mandeep / Merwat, Sheharyar K / Fair, Jeffrey H / Duarte, Alexander G

Respiratory medicine case reports

2021 Volume 33, Page(s) 101443

Abstract: Short telomere syndrome (STS) is characterized as multiorgan dysfunction presenting with unexplained cytopenias, cryptogenic cirrhosis and pulmonary fibrosis. We present a liver transplant recipient that gradually developed hypoxic respiratory failure ... ...

Abstract	Short telomere syndrome (STS) is characterized as multiorgan dysfunction presenting with unexplained cytopenias, cryptogenic cirrhosis and pulmonary fibrosis. We present a liver transplant recipient that gradually developed hypoxic respiratory failure attributed to idiopathic pulmonary fibrosis associated telomere disease that culminated in a successful single lung transplantation.
Language	English
Publishing date	2021-06-01
Publishing country	England
Document type	Case Reports
ZDB-ID	2666110-X
ISSN	2213-0071
ISSN	2213-0071
DOI	10.1016/j.rmcr.2021.101443
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Article ; Online: Immunohistochemical profile of the pulmonary vasculature in subjects with cirrhosis and histopathologic evidence of pulmonary vascular disease: An autopsy study.

Duarte, Alexander G / Hoang, Van / Boroumand, Nahal / Campbell, Gerald / Kuo, Yong-Fang / Haque, Abida

Respiratory medicine

2022 Volume 202, Page(s) 106969

Abstract: Portopulmonary hypertension (POPH) is a complication of cirrhosis that results in right ventricular failure and death. The objective of this autopsy investigation was to compare pulmonary arterial receptors in subjects with cirrhosis and histopathologic ... ...

Abstract	Portopulmonary hypertension (POPH) is a complication of cirrhosis that results in right ventricular failure and death. The objective of this autopsy investigation was to compare pulmonary arterial receptors in subjects with cirrhosis and histopathologic evidence of pulmonary vascular disease (PVD) and control group subjects with cirrhosis lacking evidence of PVD. Autopsy records of 824 subjects with cirrhosis were reviewed to identify pulmonary arterial vasculopathy. Lung sections from paraffin embedded blocks were immunostained for endothelin A (ET-A), endothelin B (ET- B), estrogen α (ER-α), estrogen β (ER-β), and vascular endothelial growth factor (VEGF). Subjects with cirrhosis and histopathologic evidence of PVD included 27 individuals with intimal hyperplasia (93%), medial hypertrophy (96%), and plexiform lesions (78%). Immunohistochemical staining for ET-A revealed positive reactivity in 40% of the group with cirrhosis and histopathologic evidence of PVD and 13% of the control group (NS). ET-B reactivity in the pulmonary endothelium and smooth muscle was identified in all subjects with cirrhosis and histopathologic evidence of PVD and control group. VEGF reactivity was identified in the endothelium in all subjects with cirrhosis and histopathologic evidence of PVD compared with 33% of the control group (p = 0.0002). ER-β reactivity was observed in four subjects (26.6%) with cirrhosis and histopathologic evidence of PVD while none in the control group (NS). Cirrhosis and histopathologic evidence of PVD was found in 3.3% of autopsies with the pulmonary vasculature immunohistochemical profile demonstrating endothelial and smooth muscle reactivity for endothelin, VEGF and ER-β.
MeSH term(s)	Autopsy ; Estrogens ; Fibrosis ; Humans ; Hypertension, Pulmonary ; Liver Cirrhosis/complications ; Liver Cirrhosis/pathology ; Lung/pathology ; Vascular Endothelial Growth Factor A
Chemical Substances	Estrogens ; Vascular Endothelial Growth Factor A
Language	English
Publishing date	2022-08-29
Publishing country	England
Document type	Journal Article
ZDB-ID	1003348-8
ISSN	1532-3064 ; 0954-6111
ISSN (online)	1532-3064
ISSN	0954-6111
DOI	10.1016/j.rmed.2022.106969
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Article ; Online: ARDS in pregnancy.

Duarte, Alexander G

Clinical obstetrics and gynecology

2014 Volume 57, Issue 4, Page(s) 862–870

Abstract: Acute respiratory distress syndrome (ARDS) is an uncommon condition in pregnant patients. The causes of ARDS are associated with obstetric causes such as amniotic fluid embolism, preeclampsia, septic abortion, and retained products of conception or ... ...

Abstract	Acute respiratory distress syndrome (ARDS) is an uncommon condition in pregnant patients. The causes of ARDS are associated with obstetric causes such as amniotic fluid embolism, preeclampsia, septic abortion, and retained products of conception or nonobstetric causes that include sepsis, aspiration pneumonitis, influenza pneumonia, blood transfusions, and trauma. An essential component in management of ARDS involves good communication between the obstetrics team and critical care specialist and a fundamental understanding of mechanical ventilatory support. Medical therapies such as nitric oxide and corticosteroids play a complimentary role. Extracorporeal life support is beneficial in the management of the parturient with severe ARDS.
MeSH term(s)	Adrenal Cortex Hormones/therapeutic use ; Extracorporeal Membrane Oxygenation/methods ; Female ; Humans ; Pregnancy ; Pregnancy Complications/therapy ; Respiration, Artificial/methods ; Respiratory Distress Syndrome, Adult/etiology ; Respiratory Distress Syndrome, Adult/therapy
Chemical Substances	Adrenal Cortex Hormones
Language	English
Publishing date	2014-12
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	391207-3
ISSN	1532-5520 ; 0009-9201
ISSN (online)	1532-5520
ISSN	0009-9201
DOI	10.1097/GRF.0000000000000067
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Article: HRCT Diagnosis of Pleuroparenchymal fibroelastosis: Report of two cases.

Morshid, Ali / Moshksar, Amin / Das, Aparna / Duarte, Alexander G / Palacio, Diana / Villanueva-Meyer, Javier

Radiology case reports

2021 Volume 16, Issue 6, Page(s) 1564–1569

Abstract: Pleuroparenchymal fibroelastosis (PPFE) is a rare idiopathic interstitial pneumonia that is often underdiagnosed on computed tomography scans. The disease process involves a combination of fibrosis involving the visceral pleura and fibroelastic changes ... ...

Abstract	Pleuroparenchymal fibroelastosis (PPFE) is a rare idiopathic interstitial pneumonia that is often underdiagnosed on computed tomography scans. The disease process involves a combination of fibrosis involving the visceral pleura and fibroelastic changes within the subpleural lung parenchyma. Although definitive diagnosis is based on pathological evaluation, this is often not feasible and pattern recognition on CT as "definite PPFE" or "consistent with PPFE" is important given that sub group of patients will undergo rapid progression with clinical deterioration.
Language	English
Publishing date	2021-04-20
Publishing country	Netherlands
Document type	Case Reports
ZDB-ID	2406300-9
ISSN	1930-0433
ISSN	1930-0433
DOI	10.1016/j.radcr.2021.03.051
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Article ; Online: Corticosteroids and Outcomes in Solid Organ Transplant Recipients Infected With Severe Acute Respiratory Syndrome Coronavirus 2

Khaled M. Nada, MD / Efstathia Polychronopoulou, MS / Gulshan Sharma, MD, MPH / Alexander G. Duarte, MD

Mayo Clinic Proceedings: Innovations, Quality & Outcomes, Vol 7, Iss 2, Pp 99-

2023 Volume 108

Abstract: Objective: To examine outcomes in organ transplant and nontransplant patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during the initial 22 months of the pandemic. Patients and Methods: We used Optum electronic health ... ...

Abstract	Objective: To examine outcomes in organ transplant and nontransplant patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during the initial 22 months of the pandemic. Patients and Methods: We used Optum electronic health records to compare outcomes between an adult transplant group and a propensity-matched nontransplant group that tested positive for SARS-CoV-2 from February 1, 2020, to December 15, 2021. Baseline characteristics, hospitalization, intensive care unit admission, mechanical ventilation, renal replacement therapy, inpatient, and 90-day mortality were compared between the transplant and nontransplant groups and among specific transplant recipients. Cox proportional analysis was used to examine hospitalization and mortality by organ transplant, medical therapy, sex, and the period of the pandemic. Results: We identified 876,959 patients with SARS-CoV-2 infection, of whom 3548 were organ transplant recipients. The transplant recipients had a higher risk of hospitalization (30.6% vs 25%, respectively; P<.001), greater use of mechanical ventilation (7.8% vs 5.6%, respectively; P<.001), and increased inpatient mortality (6.7% vs 4.7%, respectively; P<.001) compared with the nontransplant patients. The initiation of mechanical ventilation was significantly more frequent in the transplant group. After adjustment for baseline characteristics and comorbidities, the transplant group had a higher risk of hospitalization (odds ratio, 1.38; 95% confidence interval, 1.19-1.59), without a difference in mortality. In the transplant group, lung transplant recipients had the highest inpatient mortality (11.6%). Conclusion: Among patients with SARS-CoV-2 infection, the transplant recipients were at a higher risk of hospitalization and inpatient mortality; however, mortality was mainly driven by advanced age and comorbidities rather than by transplant status or immunosuppressive medications. Lung transplant recipients had the greatest inpatient and 90-day mortality.
Keywords	Medicine (General) ; R5-920
Subject code	610
Language	English
Publishing date	2023-04-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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